http://repub.eur.nl/res/concept/jel-I12/ Recent publications classified by JEL Code I12 en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/39185/ 2013-02-26T00:00:00Z Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, Kippersluis, J.L.W. van Galama, T.J. http://repub.eur.nl/res/pub/37311/ 2012-05-21T00:00:00Z We apply the theory of inequality in opportunity to measure inequity in mortality. Our empirical work is based on a rich dataset for the Netherlands (1998-2007), linking information about mortality, health events and lifestyles. We show that distinguishing between different channels via which mortality is affected is necessary to test the sensitivity of the results with respect to different normative positions. Moreover, our model allows for a comparison of the inequity in simulated counterfactual situations, including an evaluation of policy measures. We explicitly make a distinction between inequity in mortality risks and inequity in mortality outcomes. The treatment of this difference - “luck”- has a crucial in‡uence on the results. García-Gómez, P. Ourti, T.G.M. van Bago d'Uva, T. http://repub.eur.nl/res/pub/34753/ 2012-01-01T00:00:00Z The food crisis encountered in 2002 in Malawi was arguably one of the worst in the recent history of the country. The World Food Programme estimated that between 2.1 and 3.2 million people were threatened by starvation. Despite this assumed severity, not much research on the actual consequences of the crisis has been carried out so far. In order to fill this gap, this paper aims to identify the effects of the 2002 food crisis on the health status of the very young children exposed to it. Given the lack of longitudinal data and data collected during the crisis, assessing the potential impact of the 2002 events and the emergency aid that followed is challenging. We rely on representative data collected before and after the crisis and various methods from the impact evaluation literature to create a counterfactual in order to assess the implications of the crisis. Our analysis indicates that the net impact of the crisis was surprisingly low. Under-five excess mortality must have been below the 10,000 crisis-induced deaths suggested by some NGOs.Moreover, we also do not find any general and lasting loss in weight or height of children below the age of five. Nevertheless, if we disaggregate our sample population further by age and gender, we do find some nutritional impacts, both positive and negative. The positive effects identified seem to be the result of the combined influence of selective mortality and effective aid and policy interventions responding to the crisis. Hartwig, R. Grimm, M. http://repub.eur.nl/res/pub/26872/ 2011-10-01T00:00:00Z We propose tests of the two assumptions under which anchoring vignettes identify heterogeneity in reporting of categorical evaluations. Systematic variation in the perceived difference between any two vignette states is sufficient to reject vignette equivalence. Response consistency—the respondent uses the same response scale to evaluate the vignette and herself—is testable given sufficiently comprehensive objective indicators that independently identify response scales. Both assumptions are rejected for reporting of cognitive and physical functioning in a sample of older English individuals, although a weaker test resting on less stringent assumptions does not reject response consistency for cognition. Bago d'Uva, T. Lindeboom, M. O'Donnell, O.A. http://repub.eur.nl/res/pub/26873/ 2011-10-01T00:00:00Z While there is no doubt that health is strongly correlated with education, whether schooling exerts a causal impact on health is not firmly established. We exploit a Dutch compulsory schooling law to estimate the causal effect of education on mortality. The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a significant and robust negative effect on mortality. For men surviving to age 81, an extra year of schooling is estimated to reduce the probability of dying before the age of 89 by almost three percentage points relative to a baseline of 50 percent. Kippersluis, J.L.W. van O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/26870/ 2011-01-01T00:00:00Z This paper investigates the relationship between health shocks and labour market outcomes in 9 European countries using the European Community Household Panel. Matching techniques are used to control for the non-experimental nature of the data. The results suggest that there is a significant causal effect from health on the probability of employment: individuals who incur a health shock are significantly more likely to leave employment and transit into disability. The estimates differ across countries, with the largest employment effects being found in The Netherlands, Denmark, Spain and Ireland, and the smallest in France and Italy. Differences in social security arrangements help to explain these cross-country differences. García-Gómez, P. http://repub.eur.nl/res/pub/34804/ 2011-01-01T00:00:00Z Height-for-age (HA) and weight-for-age (WA) of children are standard measures to study the determinants of stunting and short-term underweight. Rather than studying these indicators separately, this paper looks at their interaction and therefore at the dynamics of height and weight. Considering HA a child's health stock and WA nutritional investment, we develop an overlapping generations model. The main features of the model are self-productivity of health stocks and the dynamic complementarity between past health stocks and contemporaneous nutrition. We test the model's predictions on a Senegalese panel of 305 children between 0 and 5 years over three periods. To control for endogeneity and serial correlation we employ different GMM methods. We find evidence of self- productive health stocks and that child health produced at one stage raises the productivity of nutritional inputs at subsequent stages. Our results indicate that child health is quickly depleted and needs constant updating. Simulations based on our estimates show that a positive nutritional shock during the first six months of life is essentially depleted at the age of 2. Consequently, sustainable development and nutrition programs have to be long-term and yield higher returns if they reach babies in the early months of infancy. Wagner, N. Rieger, M. http://repub.eur.nl/res/pub/21862/ 2010-11-01T00:00:00Z Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in health care utilisation. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of doctor visits in the direction of inequality favouring the better educated. There is a further, and typically larger, shift the same direction when correction is made for the tendency of the better educated to rate their health more negatively. Bago d'Uva, T. Lindeboom, M. O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/20413/ 2010-07-22T00:00:00Z Understanding of the substantial disparity in health between low and high socioeconomic status (SES) groups is hampered by the lack of a suffciently comprehensive theoretical framework to interpret empirical facts and to predict yet untested relations. We present a life-cycle model that incorporates multiple mechanisms explaining (jointly) a large part of the observed disparities in health by SES. In our model, lifestyle factors, working conditions, retirement, living conditions and curative care are mechanisms through which SES, health and mortality are related. Our model predicts a widening and possibly a subsequent narrowing with age of the gradient in health by SES. Galema, T.J. Kippersluis, J.L.W. van http://repub.eur.nl/res/pub/22117/ 2010-02-01T00:00:00Z A strong cross-sectional relationship between health and socioeconomic status is firmly established. This paper adopts a life cycle perspective to investigate whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of health over time. Data are drawn from the Dutch Central Bureau of Statistics (CBS) Health Interview Surveys covering the period 1983–2000. The analysis focuses on the self-rated health and disability of persons aged 16–80. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated appear to suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate. Kippersluis, J.L.W. van O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/17664/ 2010-01-03T00:00:00Z This paper examines international trade in tainted food and other low-quality products. We first find that for a large class of environments, free trade is the trading system that conveys the highest incentives to produce non-tainted high-quality goods by foreign exporters. However, free trade cannot prevent the export of tainted products, and the condition for tainting to arise becomes more easily satisfied, if the marginal cost of high-quality production increases or if errors of testing product quality matter. We also examine cases of imagebuilding investments and sabotage of rivals, and find that a tariff in either case reduces the foreign firm’s incentives to produce high quality, which in turn tends to increase import tainting. Viaene, J.M.A. Zhao, L. http://repub.eur.nl/res/pub/26886/ 2010-01-01T00:00:00Z The prevalence of overweight and obesity is growing rapidly in many countries. Education policies might be important for reducing this increase. This paper analyses the causal effect of education on the probability of being overweight by using longitudinal data of Australian identical twins. The data include self-reported and clinical measures of body size. Our cross-sectional estimates confirm the well-known negative association between education and the probability of being overweight. For men we find that education also reduces the probability of being overweight within pairs of identical twins. The estimated effect of education on overweight status increases with age. Remarkably, for women we find no negative effect of education on body size when fixed family effects are taken into account. Identical twin sisters who differ in educational attainment do not systematically differ in body size. Peer effects within pairs of identical twin sisters might play a role. Webbink, H.D. Martin, N.G. http://repub.eur.nl/res/pub/17250/ 2009-11-03T00:00:00Z Anchoring vignettes are increasingly used to identify and correct heterogeneity in the reporting of health, work disability, life satisfaction, political efficacy, etc. with the aim of improving interpersonal comparability of subjective indicators of these constructs. The method relies on two assumptions: vignette equivalence – the vignette description is perceived by all to correspond to the same state; and, response consistency - individuals use the same response scales to rate the vignettes and their own situation. We propose tests of these assumptions. For vignette equivalence, we test a necessary condition of no systematic variation with observed characteristics in the perceived difference in states corresponding to any two vignettes. To test response consistency we rely on the assumption that objective indicators fully capture the covariation between the construct of interest and observed individual characteristics, and so offer an alternative way to identify response scales, which can then be compared with those identified from the vignettes. We also introduce a weaker test that is valid under a less stringent assumption. We apply these tests to cognitive functioning and mobility related health problems using data from the English Longitudinal Survey of Ageing. Response consistency is rejected for both health domains according to the first test, but the weaker test does not reject for cognitive functioning. The necessary condition for vignette equivalence is rejected for both health domains. These results cast some doubt on the validity of the vignettes approach, at least as applied to these health domains. Bago d'Uva, T. Lindeboom, M. O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/19649/ 2009-05-01T00:00:00Z Governments of EU countries have declared that they would like to couple income growth with reductions in social inequalities in income and health. We show that, theoretically, both aims can be reconciled only under very specific conditions concerning the type of growth and the income responsiveness of health. We investigate whether these conditions were met in Europe in the 1990s using panel data from the European Community Household Panel. We demonstrate that (i) in most countries, the income elasticity of health was positive and increases with income, and (ii) that income growth was not pro-rich in most EU countries, resulting in small or negligible reductions in income inequality. The combination of both findings explains the modest increases we observe in income-related health inequality in the majority of countries. Ourti, T.G.M. van Doorslaer, E.K.A. van Koolman, A.H.E. http://repub.eur.nl/res/pub/16297/ 2009-04-01T00:00:00Z While there is no doubt that health is strongly correlated with education, whether schooling exerts a causal impact on health is not yet firmly established. We exploit Dutch compulsory schooling laws in a Regression Discontinuity Design applied to linked data from health surveys, tax files and the mortality register to estimate the causal effect of education on mortality. The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a large and significant effect on mortality even in old age. An extra year of schooling is estimated to reduce the probability of dying between ages of 81 and 88 by 2-3 percentage points relative to a baseline of 50 percent. High school graduation is estimated to reduce the probability of dying between the ages of 81 and 88 by a remarkable 17-26 percentage points but this does not appear to be due to any sheepskin effects of finishing high school on mortality beyond that predicted lin early by additional years of schooling. Kippersluis, J.L.W. van O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/14944/ 2009-02-01T00:00:00Z Rapid urbanization could have positive and negative health effects, such that the net impact on population health is not obvious. It is, however, highly pertinent to the human welfare consequences of development. This paper uses community and individual level longitudinal data from the China Health and Nutrition Survey to estimate the net health impact of China’s unprecedented urbanization. We construct an index of urbanicity from a broad set of community characteristics and define urbanization in terms of movements across the distribution of this index. We use difference-in-differences estimators to identify the treatment effect of urbanization on the self-assessed health of individuals. The results reveal important, and robust, negative causal effects of urbanization on health. Urbanization increases the probability of reporting fair or poor health by 5 to 15 percentage points, with a greater degree of urbanization having larger health effects. While people in more urbanized areas are, on average, in better health than their rural counterparts, the process of urbanization is damaging to health. Our measure of self-assessed health is highly correlated with subsequent mortality and the causal harmful effect of urbanization on health is confirmed using more objective (but also more specific) health indicators, such as physical impairments, disease symptoms and hypertension. Van de Poel, E. O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/14742/ 2009-01-01T00:00:00Z A strong relationship between health and socioeconomic status is firmly established. Yet, partly due to the multidimensional and dynamic nature of the variables, the causal mechanisms connecting them are poorly understood. This paper argues that adoption of a life-cycle perspective is essential to uncover these causal pathways. A life-cycle perspective also allows investigation of whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of their health over the life cycle. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate. The observed narrowing of the gradient in old age is partly an artefact stemming from the fact that only the most healthy of the disadvantaged survive into old age. It also reflects that after middle age, withdrawal from the labor force increasingly occurs for non health-related reasons. Kippersluis, J.L.W. van O'Donnell, O.A. Doorslaer, E.K.A. van Ourti, T.G.M. van http://repub.eur.nl/res/pub/10909/ 2008-01-18T00:00:00Z An age-cohort decomposition applied to panel data identifies how the mean, overall inequality and income-related inequality of self-assessed health evolve over the life cycle and differ across generations in 11 EU countries. There is a moderate and steady decline in mean health until the age of 70 or so and a steep acceleration in the rate of health deterioration beyond that age. In southern European countries and in Ireland, which have experienced the greatest changes in economic and social development, the average health of younger generations is significantly better than that of older generations. This is not observed in the northern European countries. In almost all countries, health is more dispersed among older generations indicating that Europe has experienced a reduction in overall health inequality over time. Although there is no consistent evidence that health inequality increases as a given cohort ages, this is true in the three largest countries – Britain, France and Germany. In the former two countries and the Netherlands, at least for males, the income gradient in health peaks around retirement age, as has been found for the US, but this pattern is not observed in the other countries. In most European countries, unlike the US, there is no evidence that income-related health inequality is greater among younger than older generations. Kippersluis, J.L.W. van Ourti, T.G.M. van Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/10482/ 2007-08-28T00:00:00Z The rural-urban gap in infant mortality rates is explained using a new decomposition method that permits identification of the ontribution of unobserved heterogeneity at the household and the community level. Using Demographic and Health Survey data for six Francophone countries in Western Sub-Saharan Africa, we find that differences in the distributions of factors that determine mortality – not differences in their effects – explain almost the entire gap. Higher infant mortality rates in rural areas mainly derive from the rural disadvantage in household level characteristics; both observed and unobserved, which explain three-quarters of the gap. Among the observed characteristics, household environmental factors—potable water, electricity and quality of housing materials—are the most important contributors explaining 38% of the gap. Unobserved household level determinants explain 10% of the gap. Community level determinants explain 13% of the gap, including 3% that is due to unobservable community level heterogeneity. Van de Poel, E. O'Donnell, O.A. Doorslaer, E.K.A. van http://repub.eur.nl/res/pub/9648/ 2007-04-10T00:00:00Z On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. We use micro data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries. First, we document the magnitude of rural-urban disparities in child nutritional status and under-five mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. We find considerable rural-urban differences in mean child health outcomes. The rural-urban gap in stunting does not entirely mirror the gap in under-five mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-five mortality fall by respectively 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows. Van de Poel, E. O'Donnell, O.A. Doorslaer, E.K.A. van